- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.19 / $7,799.00 / $21,886.00
| Facility | | $245.19 | $7,799.00 | $21,886.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.70 / $1,405.72 / $2,238.92
| Facility | | $756.70 | $1,405.72 | $2,238.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $570.65 / $570.65 / $570.65
| Facility | | $570.65 | $570.65 | $570.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $241.79 / $331.27 / $576.83
| Facility | | $241.79 | $331.27 | $576.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $461.00 / $3,866.00 / $6,584.00
| Facility | | $461.00 | $3,866.00 | $6,584.00 |